#2474 of 11K

87496

HCPCS Procedure Code

HCPCS code 87496 is the #2,474 most-billed Medicaid procedure code, with $5.5M in payments across 304K claims from 2018–2024. The national median cost per claim is $10.20. Costs vary widely — the 90th percentile is $28.50 per claim, 2.8× the median.

Total Paid

$5.5M

0.00% of all spending

Total Claims

304K

Providers

174

Avg Cost/Claim

$18

National Cost Distribution

How much do providers bill per claim for 87496? Based on 158 providers billing this code nationally.

Median

$10.20

Average

$19.75

Std Dev

$67.53

Max

$776.48

Percentile Distribution (Cost per Claim)

p10

$1.30

p25

$4.18

Median

$10.20

p75

$20.05

p90

$28.50

p95

$33.88

p99

$184.94

50% of providers bill between $4.18 and $20.05 per claim for this code.

90% bill between $1.30 and $28.50.

Top 1% bill above $184.94.

About This Procedure

HCPCS code 87496 was billed by 174 providers across 304K claims, totaling $5.5M in Medicaid payments from 2018–2024. This code was used for 255K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$10.20

Providers Billing

158

National Spending

$5.5M

Avg/Median Ratio

1.94×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 87496

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Physicians Group Laboratories, Llc Houma, LA · Clinical Medical Laboratory	$1.0M	$23.25	2.3× median	Above 75th
2	1033239413	$873K	$17.78	1.7× median	Above Median
3	1861900698	$822K	$24.69	2.4× median	Above 75th
4	1639172372	$788K	$361.15	35.4× median	Top 1%
5	Healthtrackrx Indiana, Inc Denton, TX · Clinical Medical Laboratory	$322K	$14.46	1.4× median	Above Median
6	1780059717	$223K	$35.75	3.5× median	Top 10%
7	1457977209	$177K	$12.37	1.2× median	Above Median
8	1891940326	$135K	$776.48	76.1× median	Top 1%
9	1720409154	$86K	$7.93	0.8× median	Below Median
10	1265854855	$82K	$7.06	0.7× median	Below Median
11	Laboratory Corporation Of America Holdings Burlington, NC · Clinical Medical Laboratory	$61K	$18.04	1.8× median	Above Median
12	Children's Hospital Corporation Boston, MA · Clinic/Center	$52K	$26.69	2.6× median	Above 75th
13	1316378789	$51K	$11.25	1.1× median	Above Median
14	1699162966	$50K	$9.26	0.9× median	Below Median
15	1659655124	$44K	$7.36	0.7× median	Below Median
16	1104899376	$41K	$6.52	0.6× median	Below Median
17	The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital	$40K	$18.91	1.9× median	Above Median
18	1396175196	$28K	$10.97	1.1× median	Above Median
19	1720038946	$27K	$28.42	2.8× median	Above 75th
20	1174009245	$26K	$12.43	1.2× median	Above Median

Showing top 20 of 174 providers billing this code

Related Procedures

87491Chlamydia detection, nucleic acid, amplified probe$1.39B 87502Influenza virus detection, reverse transcription, amplified probe$444.3M 87486$79.0M 87497$18.4M 87506$11.4M

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